Complementary and alternative therapies: who uses them and why, their potential and their dangers

Hamburg, Germany: The use of complementary and alternative therapies (CAMs) is widespread amongst cancer patients, and their use appears to be increasing in Europe, Dr Gillian Bendelow told the 4th European Breast Cancer Conference today (Friday 19 March).

"Doctors need to be aware that this is the case," she said. "It is simply not realistic any more for them to think that they can ignore CAMs or that they can tell their patients not to use them. Patients appear to be turning to CAMs in increasing numbers, and doctors need to take account of what other therapies their patients are using, or may use in the future, when they are considering treatment options. Some CAMs can, as their name implies, complement conventional treatments, but others have the potential to interact dangerously with drug regimes, and both doctors and patients need to be aware of this."

In her review of CAMs, Dr Bendelow, a Reader in Medical Sociology, at the School of Social Sciences and Cultural Studies, University of Sussex, UK, said: "Results from various international research studies over the last decade show an enormous variation of CAM take-up in cancer patients ranging from less than ten per cent to more than 80 per cent. One of the biggest difficulties in obtaining findings lies in defining the range of treatments and therapies that the umbrella of CAM covers. Nevertheless, the use of CAM appears to be increasing across Europe: half of general practices in England now offer patients some access to complementary or alternative medicines, and CAM is well established in Germany, apparently in dialogue with conventional medicine.

"Studies of cancer patients and the general public show that those who seek CAMs tend to be better educated, of higher socio-economic status, female, and younger than those who do not. Typically, they are more health-conscious and utilise more mainstream medical services than non-CAM users. They may decide to use CAM without consulting practitioners and it is likely that higher estimates of the numbers of users reflect the growing availability of over-the-counter and internet remedies."

Given the difficulties of categorising CAMs and the lack of research, Dr Bendelow suggested that accurate assessment of the take-up of CAMs in breast cancer, particularly in Europe, was impossible to ascertain but that trends could be predicted. "The few studies I have been able to find confirm higher rates of CAM usage among breast cancer patients in Europe: between 50-70 per cent in England and a Swedish study indicating 85 cent take-up. A 2003 study in Muenster, Germany, interviewed 203 women with breast cancer who had undergone surgery as first therapy; of these, 78 per cent used some form of CAM (most common were vitamin preparations 67 per cent, mistletoe therapy 59 per cent, and mineral preparations 33 per cent) and 70 per cent used a combination of two or more therapies."

There were a variety of reasons why women with breast cancer chose to use CAMs. These included improving the women's quality of life, giving them more control and greater responsibility for their care, and the need to explore all possibilities. More research was needed to understand how patients and practitioners made decisions about CAM usage in breast cancer. However, patients and researchers needed to be clear about the distinction between complementary and alternative therapies.

"Alternative therapies typically are promoted for use instead of mainstream treatment, which may be more controversial and especially problematic in oncology, when delayed treatment can diminish the possibility of remission and cure. Moreover, interventions sold as literal alternatives to chemotherapy, surgery, and radiation therapy may be biologically active, potentially harmful, and extremely costly. However, complementary therapies are used as adjuncts to mainstream cancer care. They include supportive measures that control symptoms, enhance well-being, and contribute to overall patient care".
Abstract no: 355 (14.15 hrs Friday 19 March, Hall 8)

Complementary and alternative therapies (CAMs) may have a role to play in palliation for cancer patients, but there is little evidence of their usefulness in the prevention or treatment of breast cancer, according to a professor of complementary medicine.

Professor Edzard Ernst told the conference: "If an effective CAM treatment or preventative measure emerged (say, a herbal medicine) it would instantly be taken up by mainstream oncology, as has happened with taxol, which comes from the yew tree. It follows, almost automatically, that all existing CAM 'cancer cures' are bogus.

"However, in palliation, our main aim is to improve quality of life and many CAM methods, such as massage, relaxation, aromatherapy and reflexology, are potentially useful for that purpose. They can ease the adverse effects of orthodox cancer therapies; for instance, acupuncture can reduce nausea and vomiting after chemotherapy."

Prof Ernst, from the Peninsula Medical School, UK, said that while many CAMS were promoted for cancer prevention or cure, there was scarce scientific data to support such claims. Examples included Essiac (a Canadian herbal mixture), Di Bella therapy (complex treatment developed by an Italian doctor), Hoxley formula (herbal mixture), mistletoe, laetrile (derived from the seeds of bitter almonds and apricots) and shark cartilage.

"Several of these alleged cancer 'cures' are associated with significant risks," he said. "Examples of risk include the adverse effects of herbal remedies, contamination or adulteration of herbal remedies, their interaction with prescribed drugs, and patients choosing to use an ineffective CAM instead of life-saving conventional treatment."